浆膜下剥离术在严重急性胆囊炎LC术中的应用研究

The Study of the Subserosal Decollement in LC for the Severe Acute Cholecystitis

摘要: 目的：探讨浆膜下剥离术在严重急性胆囊炎LC术中的应用价值。方法：回顾性分析我院2006年9月至2015年11月间198例严重急性胆囊炎病人(包括急性结石性化脓性胆囊炎，结石性坏疽性胆囊炎，非结石性化脓性胆囊炎，非结石性坏疽性胆囊炎及胆囊穿孔)，对照组(2006年9月至2011年9月)采用常规LC治疗的病人98例与治疗组(2011年9月至2015年11月)行浆膜下剥离术100例，比较二组手术时间、术中出血量、引流管保留时间、住院时间、中转开腹率等指标。结果：治疗组手术时间85.0 ± 32.3 min显著少于对照组128.0 ± 46.5 min，P < 0.001；术中出血量治疗组42.0 ± 23.6 ml显著少于对照组65.0 ± 36.5 ml，P < 0.001；引流管保留时间治疗组2.0 ± 0.5天，显著少于对照组3.0 ± 0.8天，P < 0.001；术后住院时间，治疗组4.0 ± 0.7天，显著少于对照组5.0 ± 1.8天，P < 0.001；中转开腹治疗组2例，显著少于对照组9例，P < 0.05。结论：胆囊浆膜下剥离术操作简单，损伤小，减少肝脏损伤及术中出血，缩短手术时间，对严重急性胆囊炎是较好的技术选择。

Abstract: Objective: To investigate the clinical effect of the subserosal decollement in LC for the severe acute cholecystitis. Methods: 198 patients bearded severe acute cholecystitis were retrospectively analyzed in our hospital from September 2006 to November 2006, including the acute calculous pyogenic cholecystitis, the acute calculous gangrenous cholecystitis, the acute urinary calculus pyogenic cholecystitis, the acute non calculous gangrenous cholecystitis and the perforation of gall- bladder. The control group with 98 patients (September 2006 to September 2011 in our hospital) were treated by normal LC. The treated group with 100 patients (September 2011 to November 2015 in our hospital) were treated by the subserosal decollement in LC. Then we compared the operation time, the bleeding, the rate of open cholecystectomy, the LOS (length of stay), and the time of keeping drainage tube in the two groups. Results: The operation time in the treated group was 85.0 ± 32.3 min, and in the control group was 128.0 ± 46.5 min, P < 0.001. The bleeding in the treated group was 42.0 ± 23.6 ml, and in the control group was 65.0 ± 36.5 ml, P < 0.001. The time of keeping the drainage tube, in the treated group was 2.0 ± 0.5 d, and in the control group was 3.0 ± 0.8 d, P < 0.001. The LOS after operation, in the treated group was 4.0 ± 0.7 d, and in the control group was 5.0 ± 1.8 d, P < 0.001. The open holecystectomy, in the treated group was 2 patients, and in the control group was 9 patients, P < 0.05. Conclusions: The subserosal decollement is simple, little injury to liver; it can reduce the hemorrhage and shorten operation time. It is a good choice in LC for the severe acute cholecystitis.